As I prepare to be reunited with my confiscated mobile phone at the airport, returning to the UK and media frenzy about Swine Flu, I reflect on what I have seen and learned here. TB is one of the oldest health problems in the world, a potentially deadly lung disease – extremely painful. The drugs which cure the disease are powerful and themselves make the patients feel very sick. The disease is transmitted by people coughing, spitting and sneezing; those with weakened immune systems are particularly susceptible. It is even gaining a foothold in the UK again after many years of absence.
Here in North Korea where food is often in short supply and people sleep in crowded accommodation with poor ventilation in winter, there is a serious epidemic with an incidence rate of nearly 350 new cases every year per 100,000 population compared to a global average of 38 per 100,000. TB epidemics incubate slowly and may remain undetected as disease quietly spreads through a population. Once an epidemic starts it can take years to get under control as the TB bacteria often remain undetected even as the disease continues to spread amongst the population.
As well as undertaking the major project at the National TB reference lab, CFK is already supplying up to 40% of all supplies – TB medicine and food, (more cans of chicken!) for many of the hospitals and rest homes, as well as new operating theatres like the one we saw in Sariwon. Of course there remain many challenges.
Overall, I have seen myself what a wonderful job CFK is doing, really on a shoestring. They are one of just a handful of NGOs working in the country and they are very respected as an organisation in North Korea. It is clear that they have a good co-operative working relationship with the right people and government departments, which is enabling them to get things done. But they are also realistic; they don’t make promises they can’t keep. This is all leading to them being involved in new opportunities and new work; hepatitis is the next big challenge and that could be exciting.
CFK make 3 or 4 trips a year like the one I’ve just been on, delivering supplies and checking their projects. It is not easy to go; it is certainly not a holiday and it takes planning, willingness and flexibility, but for anyone like me who has lived in and visited South Korea, life above the impermeable 38th parallel remains a subject of much curiosity. So, to go there is always fascinating – to me it now feels like South Korea did in the ‘60s.
To have the purpose of visiting CFK’s work and seeing where my donations have been spent is very special; I’ve seen some amazing things and gained a real insight into the working conditions and therefore the value and hard-earned success of this excellent charity.
On our last day, we visit the National TB Reference Laboratory in Pyongyang.
The main challenge now facing the TB system in North Korea is that they are unable to qualify to receive medicines needed to treat patients suffering from drug resistant TB strains. This is in part because they are not able to do the complex culture and sensitivity testing needed to accurately diagnose and treat drug resistant TB. Also, because they cannot provide accurate statistics on the incidence rate, they are not receiving the level of attention needed to attract stable pools of funding for medicines. 
The National TB Reference Laboratory project will mean that North Korea will be able to understand the pattern of TB transmission and prevalence much better as well as to access the necessary supplies of medicine from international funding pools. This will be an important step in substantially reducing the incidence of TB in North Korea. 
Another excursion to South Hwang Hae Province. Yesterday’s heavy rain has resulted in flooding. Today we pass through a number of places where the road is under a foot of water and the North Koreans are wading stoically through with their bicycles. At one point the road had collapsed completely and we had to cancel our visit to Umpah.
CFK has renovated and re-equipped a number of old fashioned operating theatres with a resulting increase in successful operations and a reduction in infections post-surgery.
Local officials have prioritised the construction and it has been completely rebuilt and fitted out with window frames and roofing material imported from China by CFK. A fine team effort.
Today we made an excursion out of Pyongyang to South Hwang Hae Province (Yellow Sea Province) South of Pyongyang. Our party set off down the main highway to Kaesong, which is 160 km away. The road is almost completely straight and almost completely empty. Apart from us, there was the odd speeding limousine and the occasional broken down lorry. The ratio of broken down trucks to functioning ones was remarkably high!
Something you would be hard-pressed to find anywhere else in the world was the occasional cyclist happily bicycling on the inside lane of the opposite carriageway… We ourselves drove up the wrong side of the highway through the Tae Song tunnel after our visit to one TB rest home.
Each time, we begin with a meeting at the director’s office, followed by a walk around, a visit to the laboratory and inspection of the store.
Then we visit some of the patients. They are all sitting on their beds or on the floor and are generally quite friendly, not appearing to be frightened of us unlike the last time I was here. Then I felt they avoided all eye contact as if they might get into trouble for looking at us.
CFK is supplying general medicine, food and other practical support to about 20 such hospitals and rural rest homes, a paediatric TB care facility in Pyongyang and a general paediatric hospital. In addition, the charity supplies general medicines, blankets, food supplements and canned chicken. The chicken is especially popular we are told, and we certainly see cans and cans of it, which I pass up on tasting. 
The charity also supplies plastic greenhouses which are used to grow food year round, small tractors, generators, medical and laboratory equipment. They have also arranged for boreholes to be dug to upgrade the water supply.
In the evening we went to see the Arirang Show, mass gymnastics, where tens of thousands of performers, mostly students, hold up placards in different colours to make a mosaic of pixels behind the arena, where thousands more performers stream around wearing traditional dress (the women) or military uniform (men).
The performance is mainly artistic with little political overlay. Apparently even as recently as 6 months ago there would have been more anti-American and anti-Japanese imagery; This is the same at a number of public buildings we visited, where anti-Japanese, anti-US and anti-Christian propaganda posters had now been removed, having been there for a long time. At tonight’s spectacle, the main focus is reunification, which is presented as a high priority to the people. It is an awesome experience which can only happen in a society where people have a lot of time on their hands which the state can make use of.
CFK is working with the Ministry of Public Health which oversees the civilian population, so they are our hosts. That night we had what can only be described as a banquet – 10 courses included grilled trout, barbequed beef, and beer, soju (rice wine) and even a bottle of warm Muscadet – very friendly and convivial.